1. Field of the Invention
The present invention generally relates to electronic data management systems, and more particularly relates to a system for storing, continually verifying, retrieving and transferring patient registration and payment records and funds in a global network environment.
2. Description of the Prior Art
Patients are required to transfer information about their identity, insurance coverage and medical history prior to being treated by a healthcare practitioner, such as a physician, or prior to being admitted to a hospital. This is usually performed by having the patient manually enter such information on a set of paper forms. The same patient must repeat this process prior to treatment by each new healthcare provider for the first time and for the same healthcare provider no less than once per year, as required by federal and state regulations.
For the healthcare provider obtaining this information, the information inscribed by the patient on paper forms must be manually entered into an electronic data processing system by their administrative or clerical personnel. Additionally, the personnel must undertake a range of tasks to verify the information given by the patient in order to properly bill the patient's insurer for the service rendered to the patient. Overall, the complete process is labor-intensive and therefore costly. Estimates offered by recognized industry experts indicate the total costs of the process range from $6 to $12 per patient encounter or visit.
When the information given by the patient is incomplete or invalid, or when errors occur during the manual entry of the information by the administrative or clerical staff of the healthcare provider into the electronic data processing system, the likelihood that the healthcare provider will receive proper payment from the patient's insurer declines. In recent years, federal regulations have encouraged or required healthcare providers to utilize electronic methods to transmit medical services bills to a patient's insurer. Electronic methods are binary (digital) so that the format and value of each data point transmitted by the healthcare provider must match precisely to the format and value of the data point that resides on the electronic data processing system of the insurer in order to be accepted. The mismatch of a single data point may be sufficient for a medical services bill transmitted electronically by a healthcare provider to be rejected by the insurer, thereby denying the healthcare provider of payment for the medical services rendered to the patient. Additionally, insurers have imposed limits on the amount of time a healthcare provider has to transmit a medical services bill. If a patient record is either lacking or incorrect, a healthcare provider must complete or correct the record within the set timeframe in order to be eligible for payment.
As specified by the terms of their health insurance policy, patients may be required to make a payment prior to receiving treatment by a healthcare provider. This payment is typically classified as the patient co-payment. In the past, a healthcare provider may have agreed to mail a bill to the patient at a later date for the amount of the co-payment. However, in recent years, typical health insurance policies have increased the magnitude of the co-payment. As the patient co-payment has become more substantial, healthcare providers have increasingly required the patient to make the payment prior to receiving treatment in lieu of mailing a bill at a later date. And since not all healthcare providers accept the same form of payment, a patient may not receive treatment because the patient did not possess the specific form of payment required by the healthcare provider.
It may be possible for the healthcare provider to create a system that captures patient registration at the time of entry using graphical user interfaces through a network. However, because these systems are limited by the network and exclusively for use by a specific healthcare provider, the patient is not able to use that system with, and must therefore repeat the process for, other unrelated healthcare providers. Such systems also do not include the capability to access reference databases regarding verification of data for accuracy, completeness and validity on a continuous, automated basis and, where such reference databases are not available, to initiate manual verification of data for accuracy, completeness and validity by system personnel.
In addition, it may be possible for patients to use other systems that capture patient registration at the time of entry using graphical user interfaces through a global network environment. However, these systems simply pass on information entered by patients and do not employ automated procedures to continually verify and retrieve data from reference databases or initiate manual verification by system personnel prior to making such data available to customers or transferring such data to customer databases. Without such an interim procedure, the likelihood that the healthcare provider will receive proper payment from the patient's insurer is not improved.
Further, other systems that capture patient registration at the time of entry using graphical user interfaces through a global network environment do not include the capability for patients to specify one or more funding sources to pay for the amount of a medical visit for which the patient is responsible, nor do such systems include an automated process to transfer payment from the one or more funding sources specified by the patient at time of entry to a deposit account specified by the healthcare provider.